On the use of the P300 as a tool for cognitive processing assessment in healthy aging: A review

Pavarini, Sofia Cristina Iost; Brigola, Allan Gustavo; Luchesi, Bruna Moretti; Souza, Érica Nestor; Rossetti, Estefani Serafim; Fraga, Francisco José; Guarisco, Letícia Pimenta Costa; Terassi, Marélli; Oliveira, Nathalia Alves; Hortense, Priscilla; Pedroso, Renata Valle; Ottaviani, Ana Carolina

doi:10.1590/1980-57642018dn12-010001

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Dementia & Neuropsychologia

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Views & Reviews • Dement. neuropsychol. 12 (1) • Jan-Mar 2018 • https://doi.org/10.1590/1980-57642018dn12-010001 copy

On the use of the P300 as a tool for cognitive processing assessment in healthy aging: A review

O USO DO P300 COMO FERRAMENTA PARA AVALIAÇÃO DO PROCESSAMENTO COGNITIVO EM ENVELHECIMENTO SAUDÁVEL

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Changes in patterns of performance for the cognitive functions of memory, processing speed, and focused attention are expected in old age.

Objective:

The main goal of this systematic review was to analyze the use of ERP in healthy elderly in studies evaluating the P300 components.

Methods:

A systematic review was carried out based on recommendations for nursing research on the databases LILACS, PsycINFO, PubMed, SCOPUS and Web of Science.

Results:

26 studies involving 940 healthy elderly were identified, most of which sought to identify and determine the influence of age on the P300.

Conclusion:

Although there is consensus in the literature that P300 latency is significantly longer in elderly with psychiatric disorders compared to healthy elderly, it was not possible to conclude P300 associations with gender, education and other cognitive tests.

Key words:
aging; neuropsychological function; event-related potentials; P300; healthy elderly

Reference	Study design		Sample (n; age; % female)	P300 evaluation	Complementary Evaluation	Objectives
Reference	Randomized controlled trial	Transversal	Sample (n; age; % female)	P300 evaluation	Complementary Evaluation	Objectives
Alperin et al. (2013) USA	X		• Elderly - high executive capacity (17; 74.6 years; 68.8%) • Young - high executive capacity (13; 22.5; 61.5%) • Young - average executive capacity (13; 22.6 years; 46.1%)	Visual oddball paradigm 128 electrodes	Executive Capacity testsAmerican National Adult Reading Test and MMSE	To analyze whether age-related differences in the task of processing irrelevant stimuli are uniform between the stages of information processing.
Alperin et al. (2014a) USA	X		• Elderly (29; 72.8 years; 51.7%) • Young (25; 22.6 years; 52%)	Visual oddball paradigm 128 electrodes	Executive Capacity testsAmerican National Adult Reading Test and MMSE	To compare the performance of P3 between young and elderly.
Alperin et al. (2014b) USA	X		• Elderly - high executive capacity (15; 73.9 years; 60.0%) • Elderly - average executive capacity (14; 71.6 years; 42.8%) • Young - high executive capacity (13; 22.5; 61.5%) • Young - average executive capacity (13; 22.6 years; 46.1%)	Visual oddball paradigm 128 electrodes	Executive Capacity testsAmerican National Adult Reading Test and MMSE	To understand the mechanisms involved in the increase of P3b in the elderly and young.
Asaumi et al. (2014) Japan	X		• Healthy elderly (12; 71.0 years; 75%) • Alzheimer's Disease (12; 74.1 years; 41.7%) • High risk (12; 74.3 years; 75%) • Low risk (12; 71.6 years; 50%)	Visual oddball paradigm 4 electrodes (Fz, Cz, Pz, Oz)	HDS-R, MMSE, CDR	To compare the healthy elderly group with AD and those for dementia risk.
Bashore et al. (2015) USA	X		• Elderly (34; 70.0 years; 0%) • Young (34; 27.0 years; 0%)	Visual oddball paradigm 4 electrodes (Fz, Cz Pz, Oz)	WAIS	To compare elderly and young processing information using the measures of P300 latency and reaction time.
Bender et al. (2014) Germany	X		• Healthy elderly (17; 72.3 years; 64.7%) • Alzheimer's Disease (19; 75.2 years; 35.3%) • Young healthy controls (17; 25.9 years; 41.2%)	Auditory oddball paradigm 32 electrodesP300 only in Pz	CERAD battery, MMSE, delayed verbal memory test, Wechsler Memory Scale, and GDS	To evaluate auditory processing impairment in the elderly with AD.
Kousaie, Philips (2017) Canada	X		• Monolingual speakers (21; 71.7 years; 85.7%) • Bilingual speakers (22; 68.7 years; 68.1%)	Visual oddball paradigm 64 electrodes + 8	MoCA	To examine whether monolingual and bilingual elderly differ in terms of behavioral performance and/or brain responses during the performance of multiple tasks.
Kuba et al. (2012) Czech Republic	X		• Whole group (150; 15 - 85 years; 54%)	Visual oddball paradigm 8 electrodes	--------------------	To evaluate the effects of aging on visual evoked potentials.
Lee et al. (2013) Korea	X		• Healthy elderly (31; 75.8 years; NR) • Alzheimer's Disease (31; 76.4 years; NR)	Auditory oddball paradigm 62 electrodes	K-BNT, MMSE, Word list memory, Constructional praxis, Word list recall, TMT-A/B, SBT-K	To evaluate the clinical implication of the P300 in AD patients.
Li et al.(2013) USA	X		• Elderly (13; 63.1 years; 46.1%) • Young (13; 23.9 years; 46.1%)	Visual oddball paradigm 64 electrodes + 6 (ear lobes and electrooculogram)	------------------	To examine the effects of age on the detection of target stimuli during the visual task and simultaneously to compare the contribution of the frontal and parietal regions in the task.
Lopes et al.(2014) Brazil	X		• Control (33; 60 years; 84.4%) • Parkinson disease (44; 64 years; 45.5%)	Auditory oddball paradigm 3 electrodes	MMSE, audiometry	To investigate the presence of P300 latency prolongation in PD and its association with the clinical stage of the disease.
Lucci et al. (2013) Italy	X		• Elderly (13; 69.9 years; 61.5 %) • Middle-aged (13; 50 years; 30.8%) • Young (13; 22.8 years; 30.8%)	Visual oddball paradigm 64 electrodes	------------------	To identify the effects of aging on inhibition processes.
Miranda et al. (2012) Brazil	X		• Elderly (60; 71.1 years; 66.7 %)	Auditory oddball paradigm 4 electrodes	MMSE, ADAs-Cog, GDS	To verify the association with age, cognition and depressive symptoms.
Nowak et al. (2016) Poland	X		• Elderly (20; 65.2 years; NR) • Young (20; 24.5 years; NR)	Auditory oddball paradigm 31 electrodes	MMSE, P1-N1, MMN	To determine the changes in electrophysiological response related to age.
O'Connell et al. (2012) Ireland	X		• Elderly (14; 70.6 years; 50%) • Young (15; 22.0 years; 33.3%)	Visual oddball paradigm 32 electrodes	HADS, MMSE	To evaluate the components P3a and P3b using EEG and fMRI simultaneously
Raggi et al. (2013) Italy	X		• Elderly (13; 63.9 years; 53.8%) • Young (14; 33.6 years; 57.1%)	Auditory oddball paradigm 5 electrodes	EHI, HDRSMMSE, Raven'sAdvanced Progressive Matrices	To identify the stability of their parameters in the elderly compared to the young.
Richardson, Bucks, and Hogan (2011) UK	X		• Elderly (14; 69.1 years; NR) • Young (13; 20.3 years; NR)	Auditory oddball paradigm 24 electrodes + ground + linked-mastoid reference	MMSE, MoCA, NART, HADS, RSPM	To examine the relationship between P3 caused by repeated new stimuli and a neuropsychological measure of intellectual function.
Saliasi et al. (2013) USA	X		• Elderly (40; 65.8 years; 50.0%) • Young (40; 19.9 years; 50%)	Visual oddball paradigm 64 electrodes	MMSE, HADS	To determine whether changes in brain activity related to age are associated with working memory.
Smart et al. (2014) Canada	X		• Elderly (23; 69.6 years; 76.9%) • Subjective cognitive decline (17; 69.4 years; 70.5%)	Visual oddball paradigm 32 electrodes	IQCODE, GDS, MATS, WAIS-IV, MIA, MAC-Q, BFI e +20	To evaluate people with objective cognitive complaints.
Speer and Soldan (2015) USA	X		• Elderly (19; 70.2 years; 89.5%) • Young (25, 20.1 years; 60%)	Visual oddball paradigm 32 scalp sites	NART, WAIS-R	To verify the existence of electrophysiological changes related to the cognitive reserve in healthy participants.
Tsolaki et al. (2015) Greece	X		• Elderly (18; 67.0 years; 52.9%) • Young (27; 33.0 years; 51.8%)	Auditory oddball paradigm 256 electrodes	MMSE, TMT, MMN, N400	To analyze differences in amplitude and latency for age and sex.
Zhang et al. (2013) China	X		• Health Elderly (40; 42-78 years; NR) • Post-stroke with depression (28; 43-76 years; NR) • Post-stroke without depression (39; 43-79 years; NR)	Auditory oddball paradigm 1 electrode (Cz)	N1 and N2 waves, serum ApoE, ApoE mRNA expression, HAMD	To analyze the influence of ApoE on post-stroke depression risk and to define markers for diagnosis.
Peth-Nui (2012) Thailand	X		• Placebo (20; 64.2 years; 75.0%) • 300 mg dose (20; 61.8 years; 65.0%) • 600 mg dose (20; 61.7 years; 45.0%)	Auditory oddball paradigm 1 electrode (Cz)	Computerized battery tests, words, and pictures tests	To determine the effect of B. monnieri on attention, cognitive processing, working memory, cholinergic and monoaminergic functions.
Tokuda et al. (2014) Japan	X		• Elderly (20, 62.7 year; 100%)	Auditory oddball paradigm 1 electrode (Pz)	-------------	To detect differences in cognition with ARA acid supplementation in elderly men.
Zhang et al. (2014) China	X		• Swimming (29; 64.1 years; 51.7 %) • Running (27; 65.0 years; 21.8%) • Dancing (30; 65.2 years); 53.3% • Tai Chi (28; 65.5 years; 53.5%) • Control Group (30; 64.1 years; 53.3%)	Auditory oddball paradigm 1 electrode (Cz)	SECF Cognitive Scale, HAMA, HAMD	To analyze the effects of the practice of different sports on the cognitive function of the elderly.
Wang et al. (2013) Japan	X		• Elderly (8; 62.7 years; 50%)	Auditory oddball paradigm 5 electrodes	-------------	To detect cognitive changes after Tai Chi sessions in healthy elderly.

Study	Mean ± standard deviation
Study	Amplitude (µV)	Latency (ms)
Lee et al. (2013)	6.5 ± 5.5^* * Fz electrode; 4.0 ± 2.8^ Cz electrode; 4.1 ± 5.5^* ***** Pz electrode;	362.5 ± 44.2^* * Fz electrode; 362.2 ± 43.5^ Cz electrode; 385.1 ± 38.5^* ***** Pz electrode;
Raggi et al. (2013)^a a Values related to the ISI 800ms evaluation;	5.3 ± 2.6^* * Fz electrode; 6.6 ± 2.7^ Cz electrode; 5.8 ± 2.3^* ***** Pz electrode;	357.8 ± 30.9^* * Fz electrode; 357.2 ± 31.3^ Cz electrode; 361.0 ± 33.7^* ***** Pz electrode;
Smart et al. (2014)^b b Values related to the Go stimulus;	2.2 ± 0.2^* * Fz electrode; 2.3 ± 0.2^ Cz electrode; 3.0 ± 0.2^* ***** Pz electrode;	484 ± 21^* * Fz electrode; 479 ± 16^ Cz electrode; 464 ± 16^** ****** FCz electrode.
Tokuda et al. (2014)^e e Values related to baseline; ,^g g studies did not report standard deviation from the mean.	7.34^c c Values related to healthy elderly with low arachidonic acid concentration; ^* *** Pz electrode; 10.88^d d Values related to healthy elderly with high arachidonic acid concentration; ^* ******* Pz electrode;	406^c c Values related to healthy elderly with low arachidonic acid concentration; ^* *** Pz electrode; 377^d d Values related to healthy elderly with high arachidonic acid concentration; ^* ******* Pz electrode;
Tsolaki et al. (2015)^g g studies did not report standard deviation from the mean.	3.5^* ***** Pz electrode;	428^* ***** Pz electrode;
Wang et al. (2013)^e e Values related to baseline;	18.5 ± 9.2^* * Fz electrode; 15.2 ± 4.4^ Cz electrode; 17.9 ± 3.3^* ***** Pz electrode;	351.9 ± 32.2^* * Fz electrode; 348.8 ± 33.9^ Cz electrode; 355.9 ± 31.3^* ***** Pz electrode;
Zhang, Ni and Chen (2014)^e e Values related to baseline; , ^f f Control group;	5.2 ± 1.9^ Cz electrode;	340.4 ± 23.7^ Cz electrode;
Zhang et al. (2013)	8.6 ± 2.9^ Cz electrode;	320.0 ± 20.2^ Cz electrode;

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Sofia Cristina Iost Pavarini. Graduate Program in Gerontology / Federal University of São Carlos (UFSCar) – Rodovia Washington Luís Km 310 – 13565-905 São Carlos SP – Brazil. E-mail: sofia@ufscar.br

Study	Mean ± standard deviation
Study	Amplitude (µV)	Latency (ms)
Lee et al. (2013)	6.5 ± 5.5^* * Fz electrode; 4.0 ± 2.8^ Cz electrode; 4.1 ± 5.5^* ***** Pz electrode;	362.5 ± 44.2^* * Fz electrode; 362.2 ± 43.5^ Cz electrode; 385.1 ± 38.5^* ***** Pz electrode;
Raggi et al. (2013)^a a Values related to the ISI 800ms evaluation;	5.3 ± 2.6^* * Fz electrode; 6.6 ± 2.7^ Cz electrode; 5.8 ± 2.3^* ***** Pz electrode;	357.8 ± 30.9^* * Fz electrode; 357.2 ± 31.3^ Cz electrode; 361.0 ± 33.7^* ***** Pz electrode;
Smart et al. (2014)^b b Values related to the Go stimulus;	2.2 ± 0.2^* * Fz electrode; 2.3 ± 0.2^ Cz electrode; 3.0 ± 0.2^* ***** Pz electrode;	484 ± 21^* * Fz electrode; 479 ± 16^ Cz electrode; 464 ± 16^** ****** FCz electrode.
Tokuda et al. (2014)^e e Values related to baseline; ,^g g studies did not report standard deviation from the mean.	7.34^c c Values related to healthy elderly with low arachidonic acid concentration; ^* *** Pz electrode; 10.88^d d Values related to healthy elderly with high arachidonic acid concentration; ^* ******* Pz electrode;	406^c c Values related to healthy elderly with low arachidonic acid concentration; ^* *** Pz electrode; 377^d d Values related to healthy elderly with high arachidonic acid concentration; ^* ******* Pz electrode;
Tsolaki et al. (2015)^g g studies did not report standard deviation from the mean.	3.5^* ***** Pz electrode;	428^* ***** Pz electrode;
Wang et al. (2013)^e e Values related to baseline;	18.5 ± 9.2^* * Fz electrode; 15.2 ± 4.4^ Cz electrode; 17.9 ± 3.3^* ***** Pz electrode;	351.9 ± 32.2^* * Fz electrode; 348.8 ± 33.9^ Cz electrode; 355.9 ± 31.3^* ***** Pz electrode;
Zhang, Ni and Chen (2014)^e e Values related to baseline; , ^f f Control group;	5.2 ± 1.9^ Cz electrode;	340.4 ± 23.7^ Cz electrode;
Zhang et al. (2013)	8.6 ± 2.9^ Cz electrode;	320.0 ± 20.2^ Cz electrode;